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Updated: Dec 17 2021

Pseudofolliculitis Barbae

  • Snapshot
    • A 27-year-old woman presents to her gynecologist for evaluation of bumps in her pubic area. She recently tried shaving her pubic hair. A day after she shaved, she noticed red bumps that are pruritic and painful. On physical exam, there are dozens of 1-2 mm hyperpigmented firm papules. She is counseled on available topical therapies to minimize symptoms and advised to use other methods of hair removal, such as waxing.
  • Introduction
    • Clinical definition
      • chronic inflammatory disorder of hair follicle related to shaving, characterized by painful and pruritic papules
        • “razor bumps”
        • “shave bumps”
        • “ingrown hairs”
  • Epidemiology
    • Demographics
      • male > female
      • often affects African Americans
    • Location
      • hair-bearing areas
    • Risk factors
      • shaving
      • tightly curled hair
    • Pathogenesis
      • pseudofolliculitis barbae is NOT a true folliculitis
      • inflammatory reaction occurs when hair shaft transects the wall of the hair follicle or when the hair shaft enters the epidermis
        • entrapment of short hairs causes inflammatory response
  • Presentation
    • Symptoms
      • skin lesions are painful and pruritic
    • Physical exam
      • firm and skin-colored or hyperpigmented papules and pustules
        • there may be loops of hair emerging from the follicular orifice
        • located on cheeks, jaw, or neck (in hair-bearing areas)
  • Studies
    • Labs
      • none
    • Biopsy
      • not necessary unless clinical diagnosis is unclear
    • Histology
      • intraepidermal neutrophils
      • abscess formation in dermis
      • granulomatous inflammation with foreign-body giant cells around the penetrating hair
  • Differential
    • Folliculitis
    • Cutaneous sarcoidosis
      • does not have embedded hairs and lesions may be outside of hair-bearing areas
  • Treatment
    • Conservative
      • other methods of hair removal
        • indication
          • to avoid shaving as this causes pseudofolliculitis barbae
        • modalities
          • depilatory hair removal
          • laser hair removal
          • waxing
    • Medical
      • topical therapy
        • indication
          • to reduce symptoms
        • drugs (all topical)
          • retinoids
          • corticosteroids
          • antibiotics
          • eflornithine
          • alpha-hydroxy acids (chemical exfoliants)
  • Complications
    • Scarring or keloid formation
    • Secondary bacterial infection
  • Prognosis
    • Often recurs
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